Patellofemoral Update

Patellofemoral Update

Perspective from James Bicos, MD
Perspective from John P. Fulkerson, MD
Disclosures: Gurusamy reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.
October 27, 2021
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MPFL reconstruction reduces recurrent patellar instability fivefold in adolescents

Perspective from James Bicos, MD
Perspective from John P. Fulkerson, MD
Disclosures: Gurusamy reports no relevant financial disclosures. Please see the study for all other authors' relevant financial disclosures.
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Compared with repair or no treatment, medial patellofemoral ligament reconstruction yielded the best outcomes in adolescent patients with an acute first-time patellar dislocation and an associated intra-articular loose body.

At Rady Children’s Hospital in San Diego, Pradyuma Gurusamy, MD, and colleagues performed a prospective analysis of 30 adolescent patients with acute first-time patellar dislocations and associated loose bodies who underwent MPFL reconstruction between 2015 and 2017. Researchers retrospectively analyzed data from a matched cohort of 46 adolescent patients – also with acute first-time patellar dislocation and associated loose bodies – who underwent either MPFL repair or no treatment.

According to the study, minimum follow-up was 2 years. Outcome measures included recurrent subluxation, recurrent dislocation, need for further stabilization, Kujala score, single assessment numeric evaluation score, patient satisfaction and return to sport.

Despite no differences in patient-reported outcome measures between the cohorts, Gurusamy and colleagues found MPFL reconstruction was associated with fewer instances of  recurrent instability (10%), fewer secondary procedures (6.7%) and faster return to sport (66.7%) compared with a combined rate for MPFL repair or no treatment (58.7%, 47.8% and 39.1%, respectively).

“The standard of care for the majority of patients with a first-time dislocation is nonoperative treatment,” the researchers wrote in the study. “The rate of recurrent dislocation in these patients may be up to 61% if the MPFL is repaired or not addressed surgically,” they added.

MPFL reconstruction in this adolescent population results in a “[fivefold] reduction in recurrent instability, reduces the need for subsequent surgery and improves patients’ ability to return to sports compared with repairing or not treating the MPFL,” Gurusamy and colleagues concluded.